Provider Demographics
NPI:1386225845
Name:LUSTER, JANIA R
Entity type:Individual
Prefix:
First Name:JANIA
Middle Name:R
Last Name:LUSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 ROCKAWAY BEACH BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4539
Mailing Address - Country:US
Mailing Address - Phone:929-928-7023
Mailing Address - Fax:
Practice Address - Street 1:4519 ROCKAWAY BEACH BLVD APT 303
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4539
Practice Address - Country:US
Practice Address - Phone:929-928-7023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator